Provider Demographics
NPI:1568603850
Name:JIMMY K. LU, M.D.& ASSOCIATES
Entity Type:Organization
Organization Name:JIMMY K. LU, M.D.& ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:KIEN-TEH
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-5252
Mailing Address - Street 1:3430 W WHEATLAND RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3446
Mailing Address - Country:US
Mailing Address - Phone:972-296-5252
Mailing Address - Fax:972-283-6790
Practice Address - Street 1:3430 W WHEATLAND RD
Practice Address - Street 2:SUITE 119
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3446
Practice Address - Country:US
Practice Address - Phone:972-296-5252
Practice Address - Fax:972-283-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126899701Medicaid
TXTXB107473Medicare PIN
TX126899701Medicaid